Hand impairment is a common condition that contributes substantially to disability in the U.S. and around the world. In the case of stroke alone, it is estimated that 80% of the 700,000 individuals who survive a stroke each year require hand therapy. Intensive rehabilitation exercise reduces long-term hand impairment. Unfortunately, as soon as 2 weeks after the onset of an injury, people often must perform hand therapy at home without professional assistance. Individuals rarely comply with written home programs for home therapy. To address this problem, we have developed an affordable (< $100 manufacturing cost) instrumented glove that requires the user to practice functional gripping movements to play a custom computer game inspired by the third most popular video game in gaming history, Guitar Hero. In a pilot study with 9 individuals with a stroke, we found that the MusicGlove accurately measures clinical hand impairment level, inspires people to make over 1400 practice grip movements in 40 minute training sessions, and induces clinically significant improvements in hand function. When asked how likely they would be to complete this therapy at home, they rated it a perfect 10 out 10. To move MusicGlove toward commercialization, the objectives of this Phase 1 project are to: 1) Develop a prototype of the MusicGlove suitable for at-home rehabilitation (months 1-3). We will modify our clinical prototype to withstand months of intense home use without breaking, to have an intuitive, easy-to-use game interface that is suitable for users who have minimal experience with computers, and to automatically quantify and log the user's movement and use habits. 2) Perform a usability study of this prototype and refine the design based on user feedback (months 2-3). This feedback will be obtained from individuals with hand impairment after stroke and their clinical caregivers. 3) Conduct a pilot study of at-home use of the device, comparing its performance to conventional at-home self-supervised therapy (months 4-6). We will recruit 10 individuals with a chronic stroke to use the device at home for 2 months; a control group of 10 individuals will receive a program of standard home hand exercises specified by a booklet. We hypothesize that the individuals who exercise with the MusicGlove will a) exercise their hand more than the control group; and b) improve their Box & Block score by a clinically significant amount (6 blocks), compared to the control group. This project will result in a working and tested prototype that we can push to production and generate the user experience data necessary to continue to improve the product and to move to a larger efficacy trial to be proposed in Phase II. PUBLIC HEALTH RELEVANCE: This research is relevant to public health because it will increase the accessibility and lower the costs of rehabilitation therapy for the upper extremity. This will provide a pathway to a better life for millions of U.S citizens suffering from motor impairment after stroke and other neurologic injuries. Not only does rehabilitation therapy reduce the likelihood of devastating complications, it also improves functional ability, increasing the standard of living of individuals with impairment and reducing the burden on society caused by disability.